A serum cotinine concentration greater than 10 ng/ml may predict an increased risk of wound complication in head and neck flap reconstruction and may serve as an objective, easily measured variable with which to identify patients who may benefit from an aggressive smoking cessation program before surgery.

Reconstruction of the nasal osseocartilaginous framework is the foundation of successful primary and secondary rhinoplasty. When adequate septal cartilage is unavailable, the rib provides the most abundant source of cartilage for graft fabrication and is the most reliable when structural support is needed. We present the senior author's (J.P.G.) experience and evolution of techniques of dorsal augmentation with autogenous rib cartilage grafts with internal K-wire stabilization in rhinoplasty.

The lower lateral crural turnover flap is a useful and reproducible technique in rhinoplasty with enduring results. The use of adjacent cartilage provides a local source of viable tissue to correct and support the lower lateral crura in both primary and revision rhinoplasty.

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: The authors describe in detail the techniques that they have found to be integral in harvesting rib cartilage grafts for secondary rhinoplasty.

Background. Isolated defects in the cervical esophagus in patients who have not undergone total laryngectomy are uncommon. We report 2 cases of rare esophageal tumors requiring reconstruction of the cervical esophagus after tumor resection.Methods and Results. The patients were a 51-year-old woman with an esophageal granular cell tumor and a 54-yearold woman with an esophageal schwannoma. Both defects were reconstructed with a radial forearm flap. A small subclinical leak developed in 1 patient and healed spontaneously within 2 weeks. At 1 year and 2 years of follow-up, both patients were consuming a normal diet and had normal voices.Conclusions. A thin and well-vascularized flap such as the radial forearm flap is essential for reconstructing an isolated cervical esophageal defect so as to maximize functional outcome. Keywords: cervical esophagus; esophageal reconstruction; granular cell tumor of the esophagus; schwannoma of the esophagus; radial forearm flap Schwannomas and granular cell tumors rarely arise in the esophagus. They usually do not cause clinical symptoms that prompt medical intervention. In many cases, such tumors can be enucleated without the need for esophageal resection. There have been no reports in the literature of reconstruction of the cervical esophagus with free tissue transfers after resection of esophageal schwannomas or granular cell tumors. Reconstruction of the esophagus in patients with an intact larynx and trachea is technically more difficult because of limited exposure. We present 2 cases of rare, symptomatic cervical esophageal tumors that required free flap reconstruction to restore esophageal integrity.CASE REPORTS Case 1. The patient was a 51-year-old woman who initially presented with a history of dysphagia that had lasted several months. Further workup revealed a hyperfunctioning thyroid nodule that was removed in a right thyroid lobectomy. The procedure was uncomplicated, and pathologic examination revealed a benign thyroid adenoma. The patient recovered well postoperatively but returned 1 year later with progressively worsening dysphagia Correspondence to: P. Yu

The purpose of this study was to determine whether the canine hard palate can be lengthened by distraction osteogenesis in a cleft palate model using a mostly submucosal distractor. Five mongrel dogs were used. After raising mucoperiosteal flaps, a midline strip of bone was removed from the hard palate of each dog to simulate the bony defect seen in a cleft palate. A transverse osteotomy was then made to separate the posterior segment of the hard palate from the anterior segment. Posterior osteotomies were also made laterally parallel to the teeth so that the 2 posterior segments (one on either side of the bony cleft) were mobile. An intraoral distractor that was mostly submucosal was attached to the anterior hard palate and both segments of the mobilized posterior hard palate. Radiopaque bone markers were placed, and x-rays were obtained. After a 10-day latency period, the distractor was expanded 0.675 mm per day until it had been lengthened 10.125 mm. Distractors were left in place for an additional 8 weeks. After distractor removal, animals were observed for an additional 8 weeks before euthanization. Follow-up x-rays and histologic examinations were performed. New bone formation was found at the site of distraction in all dogs at the time of death. This new bone was seen on the follow-up x-rays and on histologic examination of the hard palates using both hematoxylin and eosin staining and Masson's trichrome stain. Distraction osteogenesis using a mostly submucosal device is an effective technique for lengthening the hard palate in a canine cleft palate model. The technique may eventually provide an alternative treatment for velopharyngeal incompetence in humans that is more precise and involves less morbidity than existing treatments.

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